| Home | E-Submission | Sitemap | Contact Us
top_img
Cancer Research and Treatment > Volume 50(2); 2018 > Article
Seo, Kim, Kang, Jang, Kim, Cho, Yoo, Paik, Cha, and Yoon: The Clinical Utilization of Radiation Therapy in Korea between 2011 and 2015

Abstract

Purpose

The purpose of this study was to estimate the clinical utilization of radiation therapy (RT) in Korea between 2011 and 2015.

Materials and Methods

We analyzed the claims data from the Health Insurance Review and Assessment Service to estimate the clinical utilization of RT. The source population consisted of all patients who had any of the International Classification of Diseases 10th revision cancer diagnoses (C00-C97) and those with diagnostic codes D00-D48, who were also associated with at least one of the procedure codes related to RT.

Results

The total number of patients who received RT in 2011, 2012, 2013, 2014, and 2015 were 54,810, 59,435, 61,839, 64,062, and 66,183, respectively. Among them, the total numbers of male and female patients were 24,946/29,864 in 2011, 27,211/32,224 in 2012, 28,111/33,728 in 2013, 29,312/34,750 in 2014, and 30,266/35,917 in 2015. The utilization rate of RT in cancer patients has also increased steadily over the same period from 25% to 30%. The five cancers that were most frequently treated with RT between 2011 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer. More than half of cancer patients (64%) were treated with RT in the capital area (Seoul, Gyeonggi, and Incheon).

Conclusion

The total number of patients who underwent RT increased steadily from 2011 to 2015 in Korea. The utilization rate of RT in cancer patients is also increasing.

Introduction

Because of the decreases in the incidence of thyroid cancer, the annual cancer incidence has decreased in Korea after 2011 following a steady increase [1]. However, cancer is still a major public health problem in Korea. Radiation therapy (RT) is an effective and widespread method for treating cancer in conjunction with surgery and chemotherapy. RT is required in at least 45%-55% of newly diagnosed cancer cases [2]. A steady rise in the number of patients with cancer has increased the demand for RT in Korea. As we have reported previously [3,4], the number of patients with cancer needing RT has steadily increased over the 5 years between 2009 and 2013.
In the present study, we analyzed the claims data from the Health Insurance Review and Assessment Service (HIRA) to estimate the clinical utilization of RT in the 2011-2015 period.

Materials and Methods

We analyzed open claims data from the HIRA. The analysis methods using claims data from the HIRA are described in detail in a previous study [4]. The customized source population criteria for this study are shown in Table 1. In our previous study [3], type of healthcare facility included tertiary and secondary hospitals. However, in this study, primary and sanatorium hospitals were also included. In addition, information about patriots and veterans affairs’ insurance expenditure by the government, which were not included in the previous study, were also included in this study. The source population consisted of all patients who had any of the International Classification of Diseases 10th revision cancer diagnoses (C00-C97) and those with diagnostic codes D00-D48 (including carcinoma in situ or benign neoplasms), who were also associated with at least one of the procedure codes related to RT treatment [3]. The detailed methods of categorization for diagnostic codes are described in a previous study [3].
We analyzed the claims data from the HIRA in order to identify the total number of patients who underwent RT, and the number of patients who received RT by primary cancer diagnosis, sex, and age group between 2011 and 2015 in Korea. In addition, through the classification of the procedure codes related to RT [3], we estimated the total number of patients who received specific RT modalities, including brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic radiation therapy (SRT), and proton therapy. Considering the annual cancer incidence [1], the percentage of patients who underwent RT was calculated. We also analyzed the geographic differences for the number of patients who received RT. The number of patients was based on the location of the healthcare facilities.

Results

The total number of patients who received RT in 2011, 2012, 2013, 2014, and 2015 were 54,810, 59,435, 61,839, 64,062, and 66,183, respectively (Fig. 1). Among them, the total numbers of male and female patients were 24,946/29,864 in 2011, 27,211/32,224 in 2012, 28,111/33,728 in 2013, 29,312/34,750 in 2014, and 30,266/35,917 in 2015 (Fig. 2). The absolute number of cancer patients who received RT and the cancer incidence from 2011 to 2014 are shown in Fig. 3. The utilization rate of RT in cancer patients has also increased steadily over the same period from 25% to 30%. Because Korea’s cancer incidence in 2015 has not been reported yet, the utilization rate of RT in 2015 could not be calculated.
The distribution of patients who received RT by cancer diagnosis between 2011 and 2015 is shown in Table 2. The five cancers that were most frequently treated with RT between 2011 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer (Fig. 4A). The five most common types of cancer among the male patients were lung, liver, prostate, colorectal, and esophageal cancers, while the incidence of colorectal cancer showed a decreasing trend (Fig. 4B). Among female patients, the five most common types were breast, lung, uterine cervical, colorectal, and uterine corpus cancers, while the incidence of colorectal and uterine cervix cancer showed a decreasing trend (Fig. 4C).
Breast cancer and carcinoma in situ of breast patients accounted for nearly 30% of the total patients who underwent RT, and for approximately half of the female patients (Table 2). The diseases with code ‘D’ made up 7% of the total patients treated with RT (Fig. 1).
The utilization rates of RT in the 10 most common cancers in Korea [1] are shown in Fig. 5. The utilization rate of RT increased significantly between 2011 and 2014 for breast (from 85% to 90%), lung (from 41% to 45%), liver (from 18% to 25%), and prostate cancer (from 22% to 27%).
The distribution of patients who received RT in 2015 based on cancer diagnosis and age group is shown in Table 3. The most common cancer was that of the central nervous system for patients aged 20 years or less, while breast cancer was the most common cancer in patients aged 30-50 years, and lung cancer was the most common cancer in patients aged 60 years or more. Similar trends were observed for previous years.
The distribution of patients who received RT with specific modalities is shown in Table 4. The use of advanced RT modalities like IMRT, SRT, and proton therapy are steadily increasing every year.
Table 5 shows the distribution of patients who received RT from 2011 to 2015 in Korea for each prefecture. The population of each prefecture in 2015 is shown as a representative value [5]. The number of patients has steadily increased every year in all prefectures. More than half of cancer patients (64%) were treated with RT in the capital area (Seoul, Gyeonggi, and Incheon).

Discussion

We analyzed the clinical utilization of RT between 2011 and 2015 in Korea using claims data from the HIRA. The total number of patients who underwent RT has increased by 3%-8% per year between 2011 and 2015 (Fig. 1). As shown in Fig. 3, the annual cancer incidence in Korea has slowed after increasing until 2011 [1], and it decreased in 2014 compared with 2013. However, the number of cancer patients who underwent RT increased annually during the same period (Fig. 3). This antithetical pattern seemingly stems from a decrease in the total cancer incidence due to a decrease in the thyroid cancer incidence in recent years in Korea [1]. As shown in Fig. 5, because the role of external beam RT in well-differentiated thyroid cancer remains controversial [6], the decreasing incidence of thyroid cancer does not affect the utilization of RT in cancer patients.
While the numbers of breast, lung, and prostate cancers being treated with RT has increased every year, the numbers of colorectal and uterine cervix cancer treated with RT have not shown any increase (Fig. 4). These trends of RT for these cancers have some correlation with the increasing and decreasing trends in the incidence of these cancers (Fig. 5). Interestingly, liver cancer has shown a significant increase in the number of RT patients (Figs. 4 and 5) although the incidence of liver cancer has been the same or has slightly decreased every year in Korea [1]. The increase of RT for patients with liver cancer seems to have a correlation with the remarkable increase of utilization rate of RT (Fig. 5). This trend may be because recently many studies have reported good clinical outcomes for hepatocellular carcinoma patients receiving high dose radiation in Korea using advanced RT technologies, including IMRT, SRT, and image guided radiotherapy [7-12]. Furthermore, the Korean Practice Guidelines for the Management of Hepatocellular Carcinoma recommend RT for inoperable hepatocellular carcinoma patients [13].
Although the percentage of cancer patients who underwent RT increased from 25% to 30% during these 5 years (Fig. 3), the clinical utilization rate of RT in Korea seems to be lower than of the estimated optimal utilization rate of developed or developing countries (47%-56%) [14-16]. However, recently Mackillop et al. [17] criticized the overestimation of the optimal RT utilization rate in the previous reports and reported that optimal utilization rate is 34% considering the conditions of optimal access to RT. Because the study estimated the optimal utilization rate of RT in Korea under conditions of access to RT of Korea was not reported yet, whether 30% of RT utilization in Korea is appropriate is debatable. Nevertheless, the incidence of breast, lung, and prostate cancers that account for over 50% of RT patients is showing an increasing trend every year [1]. Therefore, the clinical utilization rate of RT among cancer patients in Korea is expected to continue to rise.
There is an overlap in years between the present and a previous study [3]; however, the number of patients who underwent RT are different between the two studies during the same period. Compared to the previous study, annually, an additional 200-300 patients underwent RT between 2011 and 2013. This difference might be because additional healthcare information that was not included in the previous study was integrated in the present study, such as information from primary and sanatorium hospitals and patriots and veterans affairs’ insurance expenditure by the government. Besides, there is lately (after 1 or more years) registered claims data in HIRA.
In terms of RT modalities, the number of cases receiving SRT has steadily increased over the last 5 years and it was notably increased especially in 2015. In 2015, the national health insurance coverage of SRT was expanded from only cranio-spinal tumors and inoperable lung cancer to whole body tumors. Similar to SRT, notable increases in the use of IMRT and proton therapy are expected in 2016 because national health insurance coverage of IMRT and proton therapy has been expanded in the second half of 2015. In addition, a second proton therapy center in Korea started operating in 2016 [18]. However, it should be kept in mind that the claims data from the HIRA only included data of the insured cases and the number of uninsured treatments could not be recorded. Therefore, the actual number of patients who received SRT, IMRT, and proton therapy are expected to be higher than the reported number.
In 2015, the population of Seoul was 19.5% of Korea’s population; however, nearly half of the patients (43.9%) treated with RT were treated in Seoul (Table 5). If we assume that the optimal rate of RT patients is equal to the percentage of population in each prefecture, Seoul had 2.25 fold of RT patients and Chungbuk had 0.35 fold of RT patients. This phenomenon of concentration in Seoul therefore seems very extreme. To explain this severe disproportion between regions, we need to analyze the infrastructure of RT in Korea. However, unfortunately, no such study has been published after 2007 [19]. We are preparing for the report about the status of the infrastructure of radiotherapy in Korea (2015).
The total number of patients who underwent RT increased steadily from 2011 to 2015 in Korea. The utilization rate of RT in cancer patients is also increasing. These trends are expected to continue because the incidences of breast and lung cancers with treatment heavily dependent on RT are also experiencing a rising trend in Korea.

Conflicts of Interest

Conflict of interest relevant to this article was not reported.

Acknowledgments

This study was supported by a grant of the Korea Institute of Radiological and Medical Sciences (KIRAMS), funded by Ministry of Science, ICT and Future Planning, Republic of Korea (1711045544; 1711042677; 1711045548; 1711045553; 1711045555/50534-2017).

Fig. 1.
The total number of patients who underwent radiation therapy between 2011 and 2015 in Korea.
crt-2017-096f1.tif
Fig. 2.
The total numbers of male and female patients who received radiation therapy between 2011 and 2015 in Korea.
crt-2017-096f2.tif
Fig. 3.
Cancer incidence and the total number of patients who received radiation therapy between 2009 and 2013 in Korea.
crt-2017-096f3.tif
Fig. 4.
The fifth most common cancer treated with radiation therapy (RT) between 2011 and 2015 in Korea. (A) All patients. (B) Male patients. (C) Female patients.
crt-2017-096f4.tif
Fig. 5.
The utilization rate of radiation therapy (RT) in the 10 most common cancer between 2011 and 2014 in Korea. NHL, non-Hodgkin’s lymphoma.
crt-2017-096f5.tif
Table 1.
Customized source population
List Criteria
Treatment period 1 Jan 2011-31 Dec 2015
Type of healthcare facility Tertiary, secondary, primary, sanatorium
Diagnostic code C00-C97, D00-D48
Type of insurance Health insurance, medical aid, patriots and veterans affairs’ insurance expenditure by government
Hospital region National
Sex Male, female
Age All ages
Table 2.
Distribution of cancer patients who underwent radiation therapy based on primary diagnosis between 2011 and 2015 in Korea
Category Primary diagnosis (diagnostic code) Yeara)
2011 2012 2013 2014 2015
Breast (C50) 13,765 15,059 15,766 16,549 17,302
Gastrointestinal Colorectum (C18-C20) 5,054 5,048 4,920 4,901 4,898
Liver (C22) 3,027 3,446 3,641 3,679 4,112
Esophagus (C15) 1,250 1,335 1,380 1,397 1,472
Stomach (C16) 1,070 1,048 1,026 992 1,013
Pancreas (C25) 782 942 906 948 998
Gallbladder and biliary (C23-C24) 778 856 879 954 985
Anus (C21) 193 213 211 203 199
Small bowel (C17) 42 39 43 35 32
Other (C26) 4 5 3 3 3
Subtotal 12,200 12,932 13,009 13,112 13,712
Thoracic Lung (C34) 8,991 9,425 10,187 10,846 10,863
Thymus (C37) 258 238 249 307 323
Mediastinum (C38) 41 44 48 47 54
Trachea (C33) 16 18 16 22 25
Other (C39) 4 3 2 1 1
Subtotal 9,310 9,728 10,502 11,223 11,266
Head and neck Larynx (C32) 773 884 964 912 903
Oropharynx (C01, C09-C10) 509 615 595 621 619
Oral cavity (C02-C06) 500 601 588 605 632
Nasopharynx (C11) 414 489 488 488 516
Salivary gland (C07-C08) 298 346 347 398 374
Hypopharynx (C12-C13) 354 394 352 437 395
Paranasal sinus (C31) 149 166 145 179 166
Nasal cavity (C30) 93 129 110 128 142
Eye and orbit (C69) 44 54 51 41 58
Lip (C00) 11 8 13 9 18
Other (C14) 19 20 14 16 17
Subtotal 3,164 3,706 3,667 3,834 3,840
Gynecologic Uterine cervix (C53) 2,453 2,481 2,540 2,425 2,466
Uterine corpus (C54-C55) 635 724 741 810 813
Ovary and tube (C56) 217 204 247 248 258
Vagina and vulva (C51-C52) 111 111 100 90 122
Other (C57-C58) 15 14 12 9 11
Subtotal 3,431 3,534 3,640 3,582 3,670
Genitourinary Prostate (C61) 1,952 2,451 2,577 2,634 2,778
Ureter and bladder (C66-C67) 498 484 531 608 602
Kidney (C64-C65) 443 422 445 454 525
Penis and testis (C60, C62-C63) 65 57 66 57 62
Other (C68) 11 14 12 18 19
Subtotal 2,969 3,428 3,631 3,771 3,986
CNS Brain (C70-C71) 1,388 1,513 1,567 1,623 1,605
Spinal cord (C72) 60 61 52 48 47
Other (C47) 45 36 52 32 46
Subtotal 1,493 1,610 1,671 1,703 1,698
Lymphoma Non-Hodgkin's lymphoma (C82-C88) 1,169 1,322 1,321 1,389 1,493
Hodgkin's disease (C81) 98 108 91 93 100
Other (C96) 22 23 21 30 33
Subtotal 1,289 1,453 1,433 1,512 1,626
Soft tissue (C46, C49) 545 581 631 648 715
Mesothelioma (C45) 14 19 18 19 29
Myeloma and plasmacytoma (C90) 316 414 442 450 459
Thyroid (C73) 354 381 357 360 309
Leukemia (C91-C95) 359 353 351 411 396
Skin (C44) 244 287 264 284 279
Malignant melanoma (C43) 215 209 225 244 241
Primary bone and cartilage (C40-C41) 213 219 170 206 223
Endocrine (C74-C75) 56 72 93 101 104
Unknown primary (C48, C76-C80, C97) 878 1,070 1,239 1,287 1,420
Total No. of cancer patients - 50,815 55,055 57,109 59,296 61,275
Carcinoma in situ of the breast (D05) 1,388 1,653 1,918 1,912 2,062
Benign neoplasm of meninges (D32) 1,022 960 1,041 1,112 1,032
Benign neoplasm of CNS (D33) 726 750 744 694 713
Benign neoplasm of endocrine (D34-D35) 229 283 304 319 308
Other D code diseases (D00-D04, D06-D31, D36-D48) 630 734 723 729 793
Total D code patients - 3,995 4,380 4,730 4,766 4,908
Total - 54,810 59,435 61,839 64,062 66,183

CNS, central nervous system.

a) Number of patients who received radiation therapy.

Table 3.
The number of patients who underwent radiation therapy by cancer diagnosis and age group in Korea (2015)
Category Primary diagnosis Age groupa)
20s or under 30s 40s 50s 60s 70s or older Total
Breast Breast (C50) 114 1,614 5,949 5,908 2,761 956 17,302
Gastrointestinal Colorectum (C18-C20) 13 140 563 1,330 1,376 1,476 4,898
Liver (C22) 10 89 447 1,332 1,326 908 4,112
Esophagus (C15) 0 2 50 328 498 594 1,472
Stomach (C16) 9 66 151 279 258 250 1,013
Pancreas (C25) 2 16 65 273 340 302 998
Gallbladder and biliary (C23-C24) 0 8 58 237 347 335 985
Anus (C21) 3 0 16 52 49 79 199
Small bowel (C17) 0 3 0 10 12 7 32
Other (C26) 0 0 0 1 2 0 3
Subtotal 37 324 1,350 3,842 4,208 3,951 13,712
Thoracic Lung (C34) 14 124 571 2,232 3,632 4,290 10,863
Thymus (C37) 9 26 71 86 79 52 323
Mediastinum (C38) 14 4 8 10 11 7 54
Trachea (C33) 1 1 5 4 7 7 25
Other (C39) 0 0 0 0 1 0 1
Subtotal 38 155 655 2,332 3,730 4,356 11,266
Head and neck Larynx (C32) 0 5 32 204 344 318 903
Oropharynx (C01, C09-C10) 2 7 58 229 211 112 619
Oral cavity (C02-C06) 15 36 77 172 166 166 632
Nasopharynx (C11) 21 44 109 162 112 68 516
Salivary gland (C07-C08) 21 23 52 100 103 75 374
Hypopharynx (C12-C13) 0 1 11 85 140 158 395
Paranasal sinus (C31) 3 3 28 42 43 47 166
Nasal cavity (C30) 4 15 20 37 26 40 142
Eye and orbit (C69) 7 3 7 15 11 15 58
Lip (C00) 0 0 2 5 3 8 18
Other (C14) 1 1 0 3 6 6 17
Subtotal 74 138 396 1,054 1,165 1,013 3,840
Gynecologic Uterine cervix (C53) 24 274 539 702 440 487 2,466
Uterine corpus (C54-C55) 9 24 129 339 213 99 813
Ovary and tube (C56) 1 13 40 98 69 37 258
Vagina and vulva (C51-C52) 0 2 12 28 21 59 122
Other (C57-C58) 0 1 1 3 5 1 11
Subtotal 34 314 721 1,170 748 683 3,670
Genitourinary Prostate (C61) 1 0 18 257 918 1,584 2,778
Ureter and bladder (C66-C67) 1 4 31 94 145 327 602
Kidney (C64-C65) 11 14 56 141 156 147 525
Penis and testis (C60, C62-C63) 12 14 7 12 7 10 62
Other (C68) 0 2 2 1 4 10 19
Subtotal 25 34 114 505 1,230 2,078 3,986
CNS Brain (C70-C71) 250 186 264 391 304 210 1,605
Spinal cord (C72) 15 5 7 6 8 6 47
Other (C47) 9 12 7 7 6 5 46
Subtotal 274 203 278 404 318 221 1,698
Lymphoma Non-Hodgkin's lymphoma (C82-C88) 78 128 220 361 331 375 1,493
Hodgkin's disease (C81) 36 19 10 15 5 15 100
Other (C96) 5 8 8 8 1 3 33
Subtotal 119 155 238 384 337 393 1,626
Soft tissue (C46, C49) 75 73 103 157 135 172 715
Mesothelioma (C45) 0 0 3 8 12 6 29
Myeloma and plasmacytoma (C90) 1 5 43 113 163 134 459
Thyroid (C73) 3 3 24 75 82 122 309
Leukemia (C91-C95) 138 54 85 69 34 16 396
Skin (C44) 5 11 14 40 53 156 279
Malignant melanoma (C43) 3 8 31 60 73 66 241
Primary bone and cartilage (C40-C41) 58 23 28 39 34 41 223
Endocrine (C74-C75) 50 11 4 24 7 8 104
Unknown primary (C48, C76-C80, C97) 20 53 168 377 429 373 1,420
Total No. of cancer patients 1,068 3,178 10,204 16,561 15,519 14,745 61,275
Carcinoma in situ of the breast (D05) 18 184 799 661 323 77 2,062
Benign neoplasm of meninges (D32) 10 36 161 319 266 240 1,032
Benign neoplasm of CNS (D33) 53 65 136 208 148 103 713
Benign neoplasm of endocrine (D34-D35) 19 41 71 84 60 33 308
Other D code diseases (D00-D04, D06-D31, D36-D48) 88 75 124 189 176 141 793
Total D code patients 188 401 1,291 1,461 973 594 4,908
Total 1,256 3,579 11,495 18,022 16,492 15,339 66,183

CNS, central nervous system.

a) Number of patients who received radiation therapy.

Table 4.
Distribution of patients who received radiation therapy according to specific radiation therapy modalities between 2011 and 2015 in Korea
Radiation therapy modality Yeara)
2011 2012 2013 2014 2015
Brachytherapy 1,421 (2.6) 1,421 (2.4) 1,404 (2.3) 1,255 (2.0) 1,247 (1.9)
Intensity-modulated radiation therapy 6,250 (11.4) 6,372 (10.7) 6,698 (10.8) 7,022 (11.0) 8,397 (12.7)
Stereotactic radiation therapy 3,122 (5.7) 6,670 (11.2) 6,772 (11.0) 7,648 (11.9) 12,228 (18.5)
Proton radiation therapy 25 (0.0) 50 (0.1) 33 (0.1) 34 (0.1) 158 (0.2)

Values are presented as number (%).

a) Percentage of the number of specific radiation therapy modalities over the total number of radiotherapy in each year.

Table 5.
Demographic data of patients who received radiation therapy between 2011 and 2015 in Korea for each prefecture
Prefecture Population (2015) [5], ×103 (%) Year
2011 2012 2013 2014 2015
Seoul 9,860 (19.5) 24,713 (45.1) 26,996 (45.4) 27,458 (44.4) 28,303 (44.2) 29,085 (43.9)
Gyeonggi, Incheon 15,284 (30.2) 10,651 (19.4) 11,543 (19.4) 12,228 (19.8) 12,859 (20.1) 13,680 (20.7)
Gangwon 1,506 (3.0) 1,308 (2.4) 1,422 (2.4) 1,365 (2.2) 1,406 (2.2) 1,501 (2.3)
Chungbuk 1,561 (3.1) 654 (1.2) 684 (1.2) 683 (1.1) 696 (1.1) 742 (1.1)
Chungnam, Daejeon 3,822 (7.5) 2,548 (4.6) 2,822 (4.7) 3,029 (4.9) 3,047 (4.7) 3,166 (4.8)
Jeonbuk 1,798 (3.5) 1,299 (2.4) 1,334 (2.2) 1,366 (2.2) 1,466 (2.3) 1,393 (2.1)
Jeonnam, Gwangju 3,274 (6.5) 2,812 (5.1) 3,024 (5.1) 3,119 (5.0) 3,195 (5.0) 3,359 (5.1)
Gyeongbuk, Daegu 5,097 (10.1) 4,062 (7.4) 4,388 (7.4) 4,702 (7.6) 4,922 (7.7) 4,926 (7.4)
Gyeongnam, Busan, Ulsan 7,827 (15.5) 6,393 (11.7) 6,774 (11.4) 7,429 (12.0) 7,652 (11.9) 7,802 (11.8)
Jeju 587 (1.1) 420 (0.7) 448 (0.8) 460 (0.8) 516 (0.8) 529 (0.8)
Total 50,616 (100) 54,810 (100) 59,435 (100) 61,839 (100) 64,062 (100) 66,183 (100)

Values are presented as number (%).

References

1. National Cancer Center. Cancer statistics in Korea: incidence, mortality, survival, and prevalence [Internet]. Goyang: National Cancer Center; 2017. [cited 2017 Jan 17]. Available from: http://ncc.re.kr/cancerStatsView.ncc?bbsnum=397&searchKey=total&searchValue=&pageNum=1.

2. Slotman BJ, Cottier B, Bentzen SM, Heeren G, Lievens Y, van den Bogaert W. Overview of national guidelines for infrastructure and staffing of radiotherapy. ESTRO-QUARTS: work package 1. Radiother Oncol. 2005;75:349–54.
crossref pmid
3. Kang JK, Kim MS, Jang WI, Seo YS, Kim HJ, Cho CK, et al. The clinical utilization of radiation therapy in Korea between 2009 and 2013. Radiat Oncol J. 2016;34:88–95.
crossref pmid pmc pdf
4. Kang JK, Kim MS, Jang WI, Kim HJ, Cho CK, Yoo HJ, et al. The clinical status of radiation therapy in Korea in 2009 and 2013. Cancer Res Treat. 2016;48:892–8.
crossref pmid pmc pdf
5. National Index System, Population in 2015 [Internet]. Daejeon: Statistics Korea; 2017. [cited 2017 Jan 17]. Available from: http://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=1007.

6. Lee N, Tuttle M. The role of external beam radiotherapy in the treatment of papillary thyroid cancer. Endocr Relat Cancer. 2006;13:971–7.
crossref pmid
7. Park SH, Kim JC, Kang MK. Technical advances in external radiotherapy for hepatocellular carcinoma. World J Gastroenterol. 2016;22:7311–21.
crossref pmid pmc
8. Kang JK, Kim MS, Cho CK, Yang KM, Yoo HJ, Kim JH, et al. Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization. Cancer. 2012;118:5424–31.
crossref pmid
9. Paik EK, Kim MS, Jang WI, Seo YS, Cho CK, Yoo HJ, et al. Benefits of stereotactic ablative radiotherapy combined with incomplete transcatheter arterial chemoembolization in hepatocellular carcinoma. Radiat Oncol. 2016;11:22.
crossref pmid pmc
10. Rim CH, Seong J. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines. Radiat Oncol J. 2016;34:160–7.
crossref pmid pmc pdf
11. Bae BK, Kim JC. The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy. Radiat Oncol J. 2016;34:168–76.
crossref pmid pmc pdf
12. Seol SW, Yu JI, Park HC, Lim DH, Oh D, Noh JM, et al. Treatment outcome of hepatic re-irradiation in patients with hepatocellular carcinoma. Radiat Oncol J. 2015;33:276–83.
crossref pmid pmc
13. Korean Liver Cancer Study Group (KLCSG); National Cancer Center Korea (NCC). 2014 KLCSG-NCC Korea practice guideline for the management of hepatocellular carcinoma. Gut Liver. 2015;9:267–317.
pmid pmc
14. Barton MB, Jacob S, Shafiq J, Wong K, Thompson SR, Hanna TP, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014;112:140–4.
crossref pmid
15. Borras JM, Lievens Y, Dunscombe P, Coffey M, Malicki J, Corral J, et al. The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis. Radiother Oncol. 2015;116:38–44.
crossref pmid
16. Rosenblatt E, Barton M, Mackillop W, Fidarova E, Cordero L, Yarney J, et al. Optimal radiotherapy utilisation rate in developing countries: An IAEA study. Radiother Oncol. 2015;116:35–7.
crossref pmid
17. Mackillop WJ, Kong W, Brundage M, Hanna TP, Zhang-Salomons J, McLaughlin PY, et al. A comparison of evidence-based estimates and empirical benchmarks of the appropriate rate of use of radiation therapy in ontario. Int J Radiat Oncol Biol Phys. 2015;91:1099–107.
crossref pmid
18. Chung K, Han Y, Kim J, Ahn SH, Ju SG, Jung SH, et al. The first private-hospital based proton therapy center in Korea: status of the Proton Therapy Center at Samsung Medical Center. Radiat Oncol J. 2015;33:337–43.
crossref pmid pmc
19. Huh SJ; Korean Society of Therapeutic Radiology and Oncology (KOSTRO). Current status of the infrastructure and characteristics of radiation oncology in Korea. Jpn J Clin Oncol. 2007;37:623–7.
crossref pmid pdf
Editorial Office
Korean Cancer Association
Room 1824, Gwanghwamun Officia
92 Saemunan-ro, Jongno-gu, Seoul 03186, Korea
TEL: +82-2-3276-2410   FAX: +82-2-792-1410   E-mail: journal@cancer.or.kr
About |  Browse Articles |  Current Issue |  For Authors and Reviewers
Copyright © Korean Cancer Association. All rights reserved.                 Developed in M2Community